Intermountain Healthcare Innovation Fund gives some more love to Redox

Redox Engine, the Madison, Wisconsin health IT startup that’s helping healthcare facilities overcome interoperability challenges has received $1 million in follow-on investment from Intermountain Healthcare Innovation Fund, according to a company release. The funding is part of Redox’s Series B round.

Redox will work with Intermountain in the Salt Lake City-based health system’s push to adopt digital health solutions that fit into their electronic health record. The company will also support applications Intermountain has developed, such as the Rehab Outcomes Management System, as part of Redox’s API platform.

Healthbox has previously run an accelerator for healthcare startups called Healthbox Studio but with the management change last year, Healthbox repositioned itself as a venture capital investment manager with an innovation platform that functions as a consultant to and collaborator with healthcare partners.

Healthbox has managed Intermountain Healthcare’s Innovation Fund since the fund’s launch in 2015. The fund is intended to source, evaluate, and invest in companies that align with Intermountain’s mission. So far the fund has made a handful of investments in healthcare startups, in addition to Redox:

Zebra Medical Vision, an Israel-based health IT business, developed a clinical decision support teaching computers to read and diagnose medical images through machine learning. Last year, Zebra closed a Series B round as it launched a consumer-facing product called Profound. The service allows individuals to upload their medical imaging scans such as computerized tomography scans and mammograms to Zebra Medical Vision’s online service, and receive an automated analysis of key clinical conditions.

Syapse is a precision medicine software meets clinical decision support startup. It seeks to improve care coordination for hospitals by extracting clinical, genomic and other molecular data from medical records, labs and pharmacies and integrating that data to offer more detailed patient profiles. By doing this, the company wants to guide doctors to find the right diagnostic test and therapeutic approach. The Intermountain fund took part in its Series C round.

The fund also invested in Utah-based genomics software developer Tute Genomics, which was later acquired by PierianDx. PierianDx seeks to enable personalized medicine for clinical labs.

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Oncora Medical and MD Anderson embark on personalized radiation oncology study

 

Philadelphia-based clinical decision support startup Oncora Medical is collaborating with University of Texas MD Anderson Cancer Center in Houston in a study to help radiation oncologists develop personalized treatment plans with the goal of improving outcomes, according to a news release. The Phase 1 study will focus on data from 2,000 breast cancer patients and last three to nine months.

Oncora’s Precision Radiation Oncology Platform will analyze data from MD Anderson’s electronic medical record system, tumor registry, radiation therapy planning system, and Brocade — a Web-based clinical documentation tool for medical records developed by MD Anderson Associate Professor of Radiation Oncology, Dr. Benjamin Smith.

Oncora will be tasked with creating interoperability between its Precision Radiation Oncology Platform and Brocade to explore the potential value of a combined product, the release said.

“Through this alliance, we hope to improve workflows and processes for radiation oncologists and simultaneously give radiation oncologists access to better information to support real-time, precision medical decision making,” Smith said in the release.

Although most people think of precision medicine as targeted therapy, Lindsay noted that the company defines precision medicine as the “right treatment for the right patient at the right time” and wants to expand the conventionally accepted definition beyond drugs and diagnostics.

The study was a year in the making and will be Oncora’s biggest endeavor to date, Lindsay said.

“Our software needs to access data across multiple software systems at a center that treats nearly 10,000 patients per year. That is part of the reason why we spent so long planning for the partnership. We want everything to go smoothly and we want to deliver MD Anderson a seamlessly integrated product.”

The study will also assess physician utilization and quality of the company’s predictive modeling efforts. But the ultimate criteria for success will be the deployment of a “functioning product” at MD Anderson, noted Lindsay.

The second phase of the of the collaboration with MD Anderson will expand the study to all cancer types treated with radiation.

One of the challenges in healthcare is de-siloing data, particularly for clinical decision support. When it comes to cancer treatment, radiation oncology data risks being siloed in different hospital software systems, which makes it tough to collect and analyze. Oncora Medical views its approach as a way to make predictive analytics and precision radiation oncology succeed.

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U of Miami Health System, Syapse join forces for cancer care

Precision medicine.

The phrase doesn’t fall on unfamiliar ears in the healthcare world. But now it’s getting an extra bit of attention with the launch of a new partnership.

Sylvester Comprehensive Cancer Center, which is part of the University of Miami Health System, and Syapse, a Palo Alto, California-based software company, have teamed up to create a precision medicine initiative specifically focused on cancer care.

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Physicians at Sylvester will be able to use Syapse’s platform to give patients more personalized care based on their clinical and molecular information.

“We bring all the data together for the physicians so they can understand what’s going on with the patient,” Jonathan Hirsch, president and founder of Syapse, told MedCity in a phone interview. “We have a decision support framework and a quality improvement framework so we can track the patient’s outcomes.”

With all the buzz surrounding precision medicine, now seemed like a better time than ever to launch the partnership.

Dr. Jonathan Trent, associate director of clinical research at Sylvester and professor of medicine at the University of Miami Miller School of Medicine, expressed a similar sentiment. “Matching a cancer patient with a certain treatment based on the cancer’s molecular profile is among the most promising treatment options in this age of personalized medicine,” he said in a statement.

Hirsch also pointed to a number of trends that are impacting the growth of precision medicine. For one, today’s science and medicine and advanced enough to target treatment more specifically.

Additionally, although the physicians are recognizing the effectiveness of precision medicine technology, they don’t always have the correct training to use it.

Patients are also taking note of precision medicine. “Patients are becoming increasingly aware, especially in cancer, of the different options that are out there,” Hirsch said. “They’re becoming very educated and are going to shop for care.”

A final cause of the momentum stems from a value-based care perspective. “A lot of health systems are looking to gain control over the most complex specialty areas,” Hirsch said. “They’re getting more sophisticated about care that necessitates a precision medicine approach.”

Moving forward, Hirsch said the partnership success will be based on cost containment, patients living longer with a higher quality of life and ensuring all patients are receiving the same level of care regardless of their location.

In early 2016, Syapse raised $25 million in Series C funding. It has partnerships with other organizations such as Intermountain Healthcare and Cancer Treatment Centers of America.

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How are hospitals using mobile devices for care?

Smartphones and tablets are commonplace in society today. But how common are they in healthcare settings?

A new survey from HIMSS Analytics, called the “2017 Essentials Brief: Mobile Study,” highlights the use of mobile technology in hospitals across the United States.

Respondents participated in the online survey from February 9 to February 15, 2017. Approximately 129 C-suite leaders, clinicians, department heads and IT professionals participated. Forty-four percent of respondents came from standalone hospitals. Another 29 percent came from multi-hospital health systems and 25 percent were from integrated delivery networks.

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As far as organization size, 33 percent of respondents were from organizations that have less than 50 beds. Twenty percent were from organizations with between 101 and 250 beds. Only 17 percent were from organizations with 501 or more beds.

The results of the survey show 79.8 percent of respondents said they use tablets to coordinate and provide patient care, and 42.6 percent said they use smartphones to do so. Despite these findings, desktop computers still take the lead for the most commonly used devices. Approximately 94.6 percent of respondents said they use desktops, and 37.2 percent said they use laptops to support care.

HIMSS Analytics Director of Research Brendan FitzGerald said he wasn’t shocked by the survey results. “I wasn’t necessarily surprised, primarily because when you look at mobile technology, it’s not widely used in the hospital setting,” he told MedCity via phone.

Among respondents who use smartphones and tablets, 76.5 percent indicated they use them to access clinical information. Approximately 70.6 percent said mobile devices are used to access EHRs and 66.2 percent said they’re used to access nonclinical information such as educational resources. Nearly half — 48.5 percent — said they use mobile devices for systemwide communication.

While healthcare organizations appear to be putting mobile devices to use in a variety of ways, there are still a number of hurdles to widespread adoption. One such barrier is security.

“There’s been such a runup of adoption that advanced security was kind of an afterthought,” FitzGerald said. “People had the normal safeguards in place, but hacking has become more sophisticated, and healthcare hasn’t kept up as much as other industries.” And mobile devices are that much harder to oversee. It’s much easier for providers lose mobile devices, thereby more easily giving unauthorized access to someone.

Looking ahead, FitzGerald noted that many people are worried that technology adoption in the healthcare world may slow down. But in his opinion, that’s not the case. “The horse is out of the barn,” he said. “Organizations aren’t going to go back and say they were better with a paper-based system. It’s here to stay.”

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65 percent of healthcare organizations have documented mobile strategy

The rise of technology in healthcare is causing many organizations to implement a mobile strategy.

This finding comes from part one of a two-part Spok report. Titled “The Evolution of Mobile Strategies in Healthcare,” part one highlights a number of key points in Spok’s annual survey. The survey results include responses from more than 300 U.S. healthcare professionals, which were gathered in February 2017. Thirty-five percent of respondents held various hospital roles such as quality directors, risk managers, infection prevention specialists and mobility engineers. Another 22 percent of respondents were physicians, 13 percent were nurses, 10 percent were IT staff members and 7 percent were executive leaders.

All the respondents answered questions about their organization’s mobile strategy — though their responses regarding the definition of “mobile strategy” varied across the board. For simplicity’s sake, Spok defined a mobile strategy as something that “brings together elements of security, technology and communications in a collective plan to improve staff productivity and enhance patient care.”

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The survey results show 65 percent of the organizations have a documented mobile strategy in place. This number has been steadily increasing through the years. In Spok’s similar 2014 survey, only 44 percent of organizations had a mobile strategy. In its 2012 survey, even fewer organizations (34 percent) had a mobile strategy.

Of the 65 percent that currently possess a mobile strategy, 21 percent have had it for less than one year. Forty percent have had a documented mobile strategy for between one and three years, and 14 percent have had it for between three and five years. The remaining 25 percent of respondents said their organization has had a mobile strategy for more than five years.

Among the organizations that have had a mobile strategy in place for more than a year, many have updated their strategy since its initial creation. According to respondents, the update stemmed from reasons such as the changing needs of end users, the availability of new mobile devices, new capabilities from their EHR vendor and alterations to strategy goals. Twenty-three percent of respondents said they were unsure of any updates to the strategy, and 7 percent said their organization has not updated its strategy.

But the implementation of a mobile strategy isn’t the only important factor.

Are the implemented strategies being reviewed and assessed? Not really. Only 32 percent of respondents said their organization has a formal review process for evaluating the success of projects such as mobile enablement. The remaining 68 percent said their organization does not have a formal review process.

While the number of organizations with a documented mobile strategy has been increasing since 2012, organizations should take a closer look at how to evaluate and improve their mobile strategies after implementation.

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With $25M fundraise, Amino launches price transparency services for employers, providers

About 16 months ago, Amino became the first for-profit company to gain access to the Centers for Medicare and Medicaid Services‘ vast database of Medicare claims. Now it’s not only expanding its price transparency services to self-insured employers and healthcare providers but also giving these groups access to this data.

The company raised a $25 million Series C round to support the launch of Amino Plus for EmployersAmino for Providers, and make its data platform available, according to a blog post about the fundraise. The physician search and appointment booking service allows consumers to search for physicians and gain information on prices based on individual conditions, service needs, health insurance coverage and personal preferences. One goal is to help hospitals improve their consumer/patient experience, particularly to find physicians in their network and make more informed decisions about their care. Another is to help self-insured employers reduce their healthcare costs.

Highland Capital Management led the round. Other investors that took included Accel, Aspect Ventures, Charles River Ventures, Northwestern Mutual Future Ventures, and Pilot Wall Group, among others.

“This phase of financing is about building the full ecosystem around Amino,” said David Vivero, Amino CEO, in a phone interview. “Through these services. we can make sure users get access to realtime deductibles, view their plan designs and [contact details].”

Vivero and his team have taken a number of steps to try to set Amino’s approach apart from other companies. Aside from the Medicare database access, it doesn’t allow physicians to pay for exclusion. Users can see whether a doctor’s rate for a given procedure is higher than, lower than, or similar to other doctors nearby. The search engine uses statistical adjustments to account for differences in the types of people doctors treat, so a doctor with healthy patients isn’t unfairly compared to a doctor who treats sicker patients. Last year, it became a Medicare consensus-based entity, a status that means Amino gets support from CMS to create healthcare quality measures that become available to other groups with the same status.

“This is a very big next step for us,” Vivero said. “In the history of American healthcare, everyone has had their own facts and that’s left consumers with conflicting data.”

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UHC, Henry Ford, HonorHealth deploy Xenex robots to reduce HAIs

Clostridium difficile bacteria, TEM

Healthcare-associated infections are an undeniable risk to patient safety. According to the CDC, approximately one in every 25 hospital patients has an HAI on any given day. In 2011, approximately 75,000 patients with HAIs died while hospitalized.

The prevalence of HAIs caused by pathogens like Clostridium difficile (or C. diff) and Staphylococcus aureus (or MRSA) is only growing. To combat such risk, hospitals and health systems are taking active steps to improve disinfection and thereby reduce infection rates.

United Hospital Center in Bridgeport, West Virginia, is one such system. It took its first step in 2010, when, upon building a new replacement hospital, it deployed a mercury UV technology disinfectant system. “I wanted to deploy this UV technology and try to keep the bioburden as low as possible,” Mark Povroznik, UHC’s vice president of quality and chief quality officer, said in a phone interview with MedCity. “We started with mercury devices.” UHC was among the first hospitals on the East Coast to use such technology, Povroznik said.

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But this past February, UHC changed its tune. “It was a good time to change from old technology to state of the art technology,” Povroznik said. “Xenex had some significant attributes, which made us change out all our systems.”

Numerous factors influenced UHC’s decision. For one, the Xenex LightStrike Germ-Zapping Robots are faster and higher-intensity than the mercury devices. Povroznik noted UHC also finds the Xenex robots easier to move from room to room. Additionally, the Xenex robots don’t need to heat up, while the mercury devices did.

The heated mercury also caused a certain odor to permeate rooms after disinfection. “While you’re doing something nice for patients, you find yourself explaining what the smell is,” Povroznik said. “You had to let the room air out before you brought a patient in.” But with the Xenex robots, that isn’t the case. There’s no odor to be detected, and as Povroznik said, the rooms smell like “an ocean breeze.”

UHC isn’t the only hospital to use Xenex LightStrike Germ-Zapping Robots. Detroit, Michigan-based Henry Ford Health System and Scottsdale, Arizona-based HonorHealth recently became the first hospitals in the country to implement Xenex’s robots in all their hospitals.

Data backs up the effectiveness of UV technology for hospital disinfection. A 2015 study in the American Journal of Infection Control found using pulsed xenon UV light for disinfection caused a 70 percent decrease in ICU C. diff infection rates.

In 2010, Povroznik said, using UV for disinfection was novel. But now, things have changed. “It’s no longer a pioneer step for hospitals to deploy UV technology,” he said.

Is UV technology the future of hospital disinfection? Perhaps. If so, it’ll be key to reducing the one in 25 hospital patients that have an HAI.

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The rise of oncology nurse navigators in the shift to value-based cancer care

A cancer diagnosis can be frightening and confusing for a patient. There’s where the nurse navigator comes in.

Navigators are often oncology nurses who offer individualized assistance to patients, their families, and their caregivers to overcome barriers in the healthcare system through the duration of the patient’s treatment. That might mean providing educational materials to a patient or working with a patient’s oncologists to help gain access to clinical trials. Sometimes a navigator’s tasks have nothing to do with a patient’s cancer diagnosis — like finding a babysitter. Helping patients manage their cancer care and plan for the future is quickly becoming as important as administering chemotherapy treatment for the roughly 1.68 million Americans diagnosed with cancer last year.

As of last summer, the job of a navigator became even more crucial, as Tricia Strusowski, a registered nurse and consultant with Georgia-based Oncology Solutions, explained during a talk at the Association of Community Cancer Center’s 43rd annual meeting in Washington, D.C., last week.

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Many of the current cancer patients in the U.S. are 65 years or older and paying for treatment using Medicare benefits. In search of a new way to provide better quality and more coordinated oncology care, the Centers for Medicare and Medicaid Services (CMS) rolled out a new model for delivering care to cancer patients over the summer last year. The Oncology Care Model (OCM) is a five-year model being tested through June 2021 with nearly 200 physician groups and 17 payers. The goal: Better care, smarter spending, and, ultimately, healthier patients.

One of OCM’s hallmarks is that all the participating practices, as well as the CMS, have committed to providing enhanced services, like navigation, to cancer patients on Medicare. Already some early results from several participating practices are showing the difference. At one oncology practice in Pennsylvania, enhanced services including navigation have resulted in a 51 percent drop in emergency room visits among cancer patients.

But as the role of the navigator becomes more important, so too does the means by which navigators can measure job performance. As of this year, a new set of 35 navigation metrics is available to oncology practices participating in the OCM. The metrics are a baseline, which can be used by any medical institution, and were developed in part by Strusowski, — she was one of the team leaders of the Standardized Metrics Task Force of the Academy of Oncology Nurse and Patient Navigators.

As the Journal of Oncology Navigation & Survivorship noted in January, the metrics set guidelines on how navigators should communicate with patients and healthcare providers to help coordinate cancer care, “evaluate professional practice and care delivery and measure the impact of navigation.”

During her talk, Strusowski mentioned that the metrics will not only help demonstrate the value of navigation, but will also help meet the OCM program’s overall goal.

“The navigator needs to stay one step ahead of the patient,” she said. “And how can you enhance the patient experience when we don’t know what to measure on our navigation programs?”

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Jefferson Health taps Teladoc for telehealth needs

Purchase, New York-based Teladoc is making moves in the telehealth space.

Jefferson Health in Philadelphia recently went live on Teladoc’s telehealth platform.

What prompted Jefferson Health to handpick Teladoc as opposed to another vendor? “Many of the other vendors were not designed the way Teladoc was,” Dr. Judd Hollander, the associate dean for strategic health initiatives at Thomas Jefferson University’s Sidney Kimmel Medical College, told MedCity in a phone interview. Instead, it was designed with health systems in mind, he pointed out. “The advantage is they have a platform that does what we need to do,” Hollander said.

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Dr. Alan Roga, president of Teladoc’s provider market, echoed that sentiment. “We understand the unique needs of hospitals and health systems and have developed a purpose-built telehealth solution specifically for them,” he said in a statement.

The Teladoc system is now part of Jefferson Health’s existing telehealth program, JeffConnect. But the new go-live doesn’t mean JeffConnect has disintegrated.

“JeffConnect still exists. It’s the brand of our program,” Hollander said. “We’ve changed nothing about JeffConnect. We’ve added the Teladoc platform, which is branded as JeffConnect, to that.”

JeffConnect, which includes inpatient care, outpatient care and transitions in care, enables patients to connect with physicians via phone, computer or tablet. Using JeffConnect, patients can see a physician in a variety of different ways. They can connect with their physicians 24/7 through on-demand visits. Patients can also schedule video visits or use the remote second opinion option to get additional thoughts on their care.

Whereas other hospitals and health systems outsource some of their telehealth visits to other providers, Jefferson Health does not. That’s what sets JeffConnect apart — patients always see a Jefferson Health physician, Hollander said. “That’s really unique about JeffConnect,” he said. “We believe our patients want to know that when you call Jefferson, you get Jefferson. We’re able to do that on this platform.”

And JeffConnect’s services aren’t limited to a certain physician specialty. “If you have an appointment, you can have it with every type of specialty at Jefferson,” Hollander said.

Though the price of a JeffConnect visit varies depending on one’s insurer, an on-demand visit currently costs $49.

Working with Teladoc and improving its JeffConnect platform aren’t the only things Jefferson Health is doing in the telehealth field. For one, it’s developing the National Academic Center for Telehealth, a hub focused on the intersection of technology and healthcare. Jefferson Health is also training medical students and residents in telehealth.

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Why is clinical research so messed up and how can it be fixed?

From left: Dr. Michael Kolodziej of Flatiron Health, Dr. Gregg Shepard of Tennessee Oncology, Dr. James Hamrick of Flatiron Health, Dr. Cary Presant of City of Hope Medical Center, Melissa Pool of the Center for Cancer and Blood Disorders

Dr. Michael Kolodziej was set to moderate a talk on developing a new infrastructure for conducting clinical trials with cancer patients. Instead, the former lead of Aetna’s oncology program and currently national medical director for New York-based health IT company Flatiron Health took his seat, looked at the panel, and then announced to the crowd he was renaming the talk.

“Why is clinical research so messed up?” he asked. “And how can we fix it?”

Kolodziej’s made his presentation, which included four other oncology experts, during the Association of Community Cancer Center’s 43rd annual meeting in Washington D.C. this week. But the reason for changing the name of this talk to the two questions Kolodziej asked quickly became apparent to the audience. After all, there’s no point in talking about a new infrastructure for clinical trials without first tackling their current troubles.

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Narrow eligibility criteria, financial feasibility, and the impediment of sheer geography are three problems that repeatedly reared their heads during the 45-minute discussion.

For Melissa Pool, a registered nurse and clinical research director at the Center for Cancer and Blood Disorders near Dallas, the geography angle was an early sticking point, especially in a state that’s as large as Texas.

“The difficulties we have are getting clinical trials out to rural communities,” she said.

Dr. Cary Presant of the City of Hope Medical Center near Los Angeles, Calif., added that part of the current challenge of conducting clinical trials is just finding appropriate trials workable at particular community sites. Presant’s group currently has about four sites with two staff at each prepared to do clinical trials. But financial feasibility remains a question in a way it isn’t for a hospital or large medical center that has the full-time staff and the resources to conduct trials.

“We find that the amount of discretionary funds to be able to do clinical trials is rapidly diminishing,” Presant said. “Unless you have a large practice, clinical trials might be a loss leader.”

There’s also something to be said about finding the perceived “perfect patient” to participate oncological trials.

“At the point of care of enrolling patients, the number one barrier is the availability of a trial to fit that patient and narrow eligibility criteria,” said Dr. Gregg Shepard of Tennessee Oncology, a large oncology group with about 100 physicians.

Of course, the whole point of conducting clinical trials is to test the efficacy of new drugs or treatments, which might be a boon to cancer patients willing to take risks in the course of their treatment programs.

But it’s often more difficult to enroll most cancer patients in clinical trials. Present said many drug companies want patients without comorbidities or without prior cancer. Most cancer patients do have comorbidities that they are treating in tandem with their cancer.

The overarching problem, it seems, is that clinical trials in their current state aren’t exactly representative of the population of people in the U.S. who have cancer.

Where there does appear to be some hope for the future of clinical trials is in the continuing digitization of health, something that Dr. James Hamrick, a practicing physician with Kaiser Permanente Georgia and senior medical director for Flatiron Health touched on. The data that doctors enter at the point of care, the routine that goes into all cancer patient encounters, can be harnessed to guide clinical trials. This can be done in a retrospective way — by gathering patient data in the aggregate, and then analyzing it to get a real-time, big-picture sense of cancer care in the U.S. It can also be done in a prospective way, by using the data to inform whether eligibility criteria of future trials should be loosened.

“It’s one of the promises of the digitization of healthcare,” Hamrick said. “It’s also part of the implicit bargain we make with patients when we click away on computers in the exam room with patients. There’s an assumption that the data we’re putting into the computer is going somewhere and being used to help other cancer patients.”

Using medical data will never replace the randomized clinical trial, Hamrick said. But with data, doctors in the future can stay one step ahead of trials by understanding who among their patients would be eligible for them. In a talk filled with important examinations of problems, the angle on healthcare data provided a spot of hope for reforming how clinical trials are done in the future.

Photo: From left: Dr. Michael Kolodziej of Flatiron Health, Dr. Gregg Shepard of Tennessee Oncology, Dr. James Hamrick of Kaiser Permanente, Dr. Cary Presant of City of Hope Medical Center, Melissa Pool of the Center for Cancer and Blood Disorders

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